Basic Information
| Provider Information | |||||||||
| NPI: | 1467874396 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | COMPERE | ||||||||
| FirstName: | HUBERTE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14 FORDHAM RD | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021343006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177826460 | ||||||||
| FaxNumber: | 6177826444 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 FORDHAM RD | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021343104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177826460 | ||||||||
| FaxNumber: | 6177826444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2014 | ||||||||
| LastUpdateDate: | 12/10/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TM1800X | 1467874396 | MA | Y | Behavioral Health & Social Service Providers | Psychologist | Mental Retardation & Developmental Disabilities | 172V00000X | 1467874396 | MA | N | Other Service Providers | Community Health Worker | 251B00000X | N | Agencies | Case Management |
No ID Information.